Gender/Age: Female in their 50’s
History: Adult-onset asthma, nasal polyps, allergic rhinitis, and gastroesophageal reflux disease (GERD)

• Poor asthma control
• two exacerbations in the past year requiring oral corticosteroids (OCS)

Asthma Control Test (ACT): Score of 13 (indicating poor control) Lung Function: Reduced but reversible; 78% predicted Eosinophils: 250/µL Total IgE: 40 kU/L

The elevated FeNO and eosinophil count indicated Type 2 inflammation. The patient had persistent inflammation despite moderate treatment, suggesting a need for more intensive therapy.

Inhaled Corticosteroid (ICS): The patient’s ICS dose was increased to high-dose ICS-LABA to better control her asthma.
Addition of LAMA: A long-acting antimuscarinic (LAMA) was added to her therapy, putting her on triple inhaled therapy (ICS, LABA, and LAMA).
Monitoring: Close monitoring of her symptoms, lung function, and FeNO levels was scheduled to assess the treatment’s effectiveness.

After the treatment adjustment, her ACT improved to 16, and she had no further exacerbations at this point. FeNO: Reduced to 25 ppb, showing improved control.
Eosinophils: Increased to 350/µL, and IgE remained stable at 35 kU/L.

Given the persistent inflammation and elevated eosinophils despite high-dose therapy, biologic therapy was considered. FeNO and eosinophil levels were used to guide the decision on which biologic treatment would be most appropriate.